Sláintecare Implementation Strategy & Action Plan 2021 — 2023

Objectives

Sláintecare sets out a ten-year reform vision for a universal, single-tier health and social care system in which access is based on need rather than ability to pay. It aims to provide comprehensive primary, acute and social care, delivering the right care in the right place and at the right time, at low or no cost to patients.[1][2]The 2021–2023 Strategic Action Plan translates this vision into two reform programmes: improving safe, timely access to care while promoting health and wellbeing; and addressing health inequalities while progressing towards universal healthcare.[3][4]

• Strengthen prevention, population health and healthy living through a whole-of-government and whole-of-society approach spanning homes, communities, education, workplaces, sport and other settings.[5][6]
• Shift care safely from acute hospitals to community settings, supporting people to live independently at home for as long as possible through integrated primary, community, social and specialist care.[7][8]
• Improve hospital productivity, patient flow, bed and theatre use, length of stay and discharge arrangements while expanding capacity to meet demand and reduce waiting times.[9][8]
• Develop integrated pathways covering prevention, diagnosis, treatment, discharge and follow-up, including chronic disease management and care for older people.[10][11]
• Reduce health inequalities through population profiling, needs assessment, targeted Healthy Communities activity, regional service planning, eligibility reform and population-based resource allocation.[12][13][4]
• Advance digital health infrastructure, including shared care records, electronic prescribing, electronic discharge, waiting-list management, decision-support systems and patient-facing digital services.[14][12]
• Promote patient-centred, timely and accountable care, underpinned by the Sláintecare principles of needs-based access, prevention, free care at the point of delivery, workforce support, value for money and public engagement.[15]

Reform Programme 1 is organised around the Health Service Capacity Review and its Healthy Living, Enhanced Community Care and Hospital Productivity workstreams.[5]It encompasses capacity expansion, integrated-care innovation, streamlined pathways, elective centres in Dublin, Cork and Galway, a multi-annual waiting-list reduction plan, eHealth implementation and the removal of private care from public hospitals through the Sláintecare Consultant Contract.[5]Reform Programme 2 focuses on a Citizen Care Masterplan, the Sláintecare Healthy Communities Programme, six Regional Health Areas and implementation of the Obesity Policy and Action Plan 2016–2025.[16][4]

The plan also identifies enabling programmes as cross-cutting foundations for reform, covering political and public engagement, citizen and staff empowerment, patient safety, quality improvement, antimicrobial resistance, and infection prevention and control.[17][18]

Implementation

Implementation uses a programme-management model covering 11 projects across the two reform programmes, coordinated by the Sláintecare Programme Implementation Office in the Department of Health.[3][18]The Office develops the implementation approach, establishes governance and resources, works with the Department of Health, Health Service Executive and partners, builds capacity, communicates with stakeholders, monitors performance and oversees delivery of the Strategic Action Plan.[18][19]

• Assign defined project teams, leads, plans and, where required, Project Initiation Documents covering governance, outcomes, deliverables, milestones, dependencies, risks and funding availability.[19]
• Deliver Enhanced Community Care nationally through Community Healthcare Networks, Community Specialist Hubs, Community Intervention Teams, virtual wards, primary care centres, chronic disease management, community diagnostics and expanded home support.[8][20]
• Develop standardised care pathways with general practitioners, community and hospital providers, specialist teams, residential-care partners and clinical programmes.[10]
• Use Integration Innovation Funds, proof-of-concept testing, mainstreaming and a learning network to identify and scale safer integrated-care models.[5][8]
• Implement prevention activity with cross-government, local-authority, education, community, voluntary, sporting and other partners, including physical activity, healthy eating, smoking cessation, alcohol-harm reduction, screening and mental-health initiatives.[6][21]
• Develop population-based planning through profiling, risk segmentation and health-needs assessment, linking service redesign, capital development, workforce planning and resource allocation to local population need.[13][22]
• Establish Regional Health Areas through a business plan and change-management programme intended to strengthen clinical and corporate governance, accountability, population-based planning and integration between community and acute services.[23]
• Engage frontline staff, healthcare workers, communities, the public, policymakers, voluntary organisations, representative bodies, private providers and political institutions in reform delivery.[3][15][17]

Delivery is supported by increased 2021 investment in staffing, infrastructure, community services, acute and community bed capacity, access to care and eHealth.[24][25]The 2021 Sláintecare Reform Budget allocated more than 1.235 billion euro, including capital funding, for defined reform initiatives.[24][26][27]The approach also draws on innovation and collaboration developed during the COVID-19 response, including research, learning webinars and examination of changed service pathways and technology use.[7][28][26]

Monitoring combines programme and project critical paths, regularly updated Risk, Actions, Issues and Dependencies logs, periodic progress reporting and a review after the first full year to allow reprioritisation where necessary.[19]Specific mechanisms include the Healthy Ireland Outcomes Framework for prevention work, Health Service Capacity Review metrics, evaluation of integration projects, waiting-list reporting, patient-experience surveys, clinical audit and incident reporting.[6][8][14][17][18]The plan sets waiting-time ambitions of 12 weeks for inpatient procedures, 10 weeks for outpatient appointments, 10 days for diagnostics and movement towards a four-hour maximum emergency-department wait.[9]

Accountability is supported by regular reporting to the Cabinet Committee on Health and the Joint Oireachtas Committee on Health, alongside the Health Service Executive Board, Regional Health Areas, patient-safety arrangements and stakeholder engagement structures.[2][28]Although multiple monitoring tools and project-specific metrics are identified, the supplied material does not specify one consolidated indicator set, universal reporting timetable or independent accountability mechanism for all 2021–2023 projects.[19][25]

Monitoring & Evaluation

The implementation framework combines programme-level oversight, project management, outcomes monitoring, service-performance reporting and evaluation. The Sláintecare Programme Implementation Office is responsible for monitoring reform performance and impacts, evaluating implementation, reporting regularly on plans and progress, and reviewing the Strategic Action Plan after its first full year to support realignment or reprioritisation.[18][19]

• Monitor reform delivery through project teams, nominated leads, project plans, critical paths and regularly updated Risk, Actions, Issues and Dependencies logs with assigned owners.[19]
• Report progress to the Cabinet Committee on Health and the Joint Oireachtas Committee on Health, alongside periodic implementation updates published by the Programme Implementation Office.[2][25]
• Track waiting-list reduction through identification and reporting of waiting lists across community, social care, hospital, diagnostic and palliative-care services, supported by a national management system, public information and performance visualisation.[14]
• Measure Healthy Living and prevention activity through the Healthy Ireland Outcomes Framework, including evaluation of prevention initiatives and monitoring of the Physical Activity Plan.[6][21][29]
• Assess capacity and productivity using the Health Service Capacity Review 2018 reporting framework and metrics, including measures for Healthy Living, Enhanced Community Care, hospital productivity and capacity implementation.[20][12][25]
• Evaluate Integration Innovation Fund projects as proof-of-concept models, mainstream successful projects where appropriate, and monitor the progress and impacts of scaled integrated-care initiatives through learning networks and webinars.[8][30]
• Develop metrics for implementation of Sharing the Vision, evaluate reformed home-support delivery, and review community healthcare networks, virtual wards, falls-prevention teams and new clinical pathways.[31][11][29]
• Use population profiling, health-needs assessment and movement between population risk segments to assess preventive interventions, service redesign and resource allocation.[16][13]
• Develop baselines and outcome measures for Healthy Communities, monitor community and obesity initiatives, and undertake research and evaluation to inform wider rollout.[4][32]
• Strengthen accountability through the Health Service Executive Board, six Regional Health Areas, the Patient Safety Office, staff-engagement structures, programme governance and the Obesity Policy Implementation Oversight Group.[23][33][28]
• Use patient-experience surveys, open disclosure, incident reporting, clinical guidelines and clinical audit to support safe care and quality improvement; the National Care Experience Programme had two established surveys and planned three further surveys during the plan period.[17][18]
• Require reporting of serious incidents to relevant regulators under the Patient Safety (Notifiable Patient Safety Incidents) Bill 2019, including the Health Information and Quality Authority and the Mental Health Commission.[18]

The extracts do not provide one consolidated indicator framework, full reporting timetable, surveillance system, independent audit process or comprehensive evaluation methodology for all 11 projects.[15][32][34]

Costing & Financing

Budget 2021 provided more than 1.235 billion euro for Sláintecare initiatives, intended to expand infrastructure, staffing, community services and access to care; 136 million euro of the total was capital funding.[24][26][27]

• Allocate funding for acute and community bed capacity, Enhanced Community Care, social care, national strategies, improved access to care and eHealth.[25]
• Support Enhanced Community Services through 150 million euro in 2021, within total investment of 186 million euro over 2020 to 2021.[26]
• Provide 95 million euro of eHealth capital funding and 33 million euro of eHealth revenue funding in 2021.[27]
• Link project planning to identified funding availability and maintain targeted, protected reform funding.[19]
• Develop a Population-Based Resource Allocation Funding Model and costing framework, including analysis of spending by population segment, service gaps and investment opportunities.[4][32]
• Cost and test the eligibility and entitlement policy framework before any implementation proposed for Government approval.[32]
• Condition expansion of Healthy Communities beyond the initial 18 areas, and the proposed addition of 39 Community Healthcare Networks in 2022, on available funding.[29][32]
• Subject elective-centre development to Government decisions and the Public Spending Code, including Strategic Assessment Report and Preliminary Business Case approvals.[10][31]

The extracts identify no quantified funding gap, project-level costings for most reforms, financing shares, external funding sources or detailed economic assumptions. Economic risks noted include COVID-19-related deterioration, Brexit-related shocks and the need to demonstrate value for money.[24]